Osteoporosis International

, Volume 19, Issue 12, pp 1741–1747

Reversal of the hip fracture secular trend is related to a decrease in the incidence in institution-dwelling elderly women

  • E. Guilley
  • T. Chevalley
  • F. Herrmann
  • D. Baccino
  • P. Hoffmeyer
  • C.-H. Rapin
  • R. Rizzoli
Original Article



In this prospective 10-year study in elderly aged 60 years and over, there was a 1.3% per year reduction in the standardized incidence of hip fracture in women but not in men. This decrease was mainly due to changes in the standardized incidence of hip fracture in institution-dwelling women.


A decrease in age-adjusted hip fracture incidence has been recently demonstrated in some countries. Since a large proportion of hip fractures occur in nursing homes, we analyzed whether this decreasing trend would be more detectable in institution-dwelling elderly compared with community-dwelling elderly.


All hip fracture patients aged 60 years and over were identified in a well-defined area. Incidence of hip fracture, age- and sex-adjusted to the 2000 Geneva population, was computed in community- and institution-dwelling elderly.


From 1991 to 2000, 1,624 (41%) hip fractures were recorded in institutionalized-dwelling elderly and 2,327 (59%) in community-dwelling elderly. The standardized fracture incidence decreased by 1.3% per year in women (p = 0.039), but remained unchanged in men (+0.5%; p = 0.686). Among institution-dwelling women, hip fracture incidence fell by 1.9% per year (p = 0.044), whereas it remained stable among community-dwelling women (+0.0%, p = 0.978). In men, no significant change in hip fracture incidence occurred among institution- or community-dwelling elderly.


The decrease in the standardized hip fracture incidence in institution-dwelling women is responsible for the reversal in secular trend. Future research should include stratification according to the residential status to better identify the causes responsible for the trend in hip fracture incidence.


Epidemiology Hip fracture Incidence Nursing homes Prevention Secular trend 


  1. 1.
    Keene G, Parker M, Pryor G (1993) Mortality and morbidity after hip fractures. BMJ 307:1248–1250PubMedCrossRefGoogle Scholar
  2. 2.
    Johnell O, Kanis J (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733PubMedCrossRefGoogle Scholar
  3. 3.
    Brennan J, Johansen A, Butler J et al (2003) Place of residence and risk of fracture in older people: a population-based study of over 65-year-olds in Cardiff. Osteoporos Int 14:515–519CrossRefGoogle Scholar
  4. 4.
    Butler M, Norton R, Lee-Joe T et al (1996) The risks of hip fracture in older people from private homes and institutions. Age Ageing 25:381–385PubMedCrossRefGoogle Scholar
  5. 5.
    Cumming RG (1996) Nursing home residence and risk of hip fracture. Am J Epidemiol 144:1191–1194Google Scholar
  6. 6.
    Norton R, Campbell AJ, Reid IR et al (1999) Residential status and risk of hip fracture. Age Ageing 28:135–139PubMedCrossRefGoogle Scholar
  7. 7.
    Ooms ME, Vlasman P, Lips P et al (1994) The incidence of hip fractures in independent and institutionalised elderly people. Osteoporos Int 4:6–10PubMedCrossRefGoogle Scholar
  8. 8.
    Balasegaram S, Majeed A, Fitz-Clarence H (2001) Trends in hospital admissions for fractures of the hip and femur in England, 1989–1990 to 1997–1998. J Public Health Med 23:11–17PubMedCrossRefGoogle Scholar
  9. 9.
    Boufous S, Finch CF, Lord SR (2004) Incidence of hip fracture in New South Wales: are our efforts having an effect? Med J Aust 180:623–626PubMedGoogle Scholar
  10. 10.
    Hernandez JL, Olmos JM, Alonso MA et al (2006) Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int 17:464–470PubMedCrossRefGoogle Scholar
  11. 11.
    Huusko TM, Karppi P, Avikainen V et al (1999) The changing picture of hip fractures: dramatic change in age distribution and no change in age-adjusted incidence within 10 years in Central Finland. Bone 24:257–259PubMedCrossRefGoogle Scholar
  12. 12.
    Lau EM, Cooper C, Fung H et al (1999) Hip fracture in Hong Kong over the last decade—a comparison with the UK. J Public Health Med 21:249–250PubMedCrossRefGoogle Scholar
  13. 13.
    Chang KP, Center JR, Nguyen TV et al (2004) Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo osteoporosis epidemiology study. J Bone Miner Res 19:532–536PubMedCrossRefGoogle Scholar
  14. 14.
    Jaglal S, Weller I, Mamdani M et al (2005) Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20:898–905PubMedCrossRefGoogle Scholar
  15. 15.
    Kannus P, Niemi S, Parkkari J et al (2006) Nationwide decline in incidence of hip fracture. J Bone Miner Metab 21:1836–1838Google Scholar
  16. 16.
    Melton LJ, Atkinson EJ, Madhok R (1996) Downturn in hip fracture incidence. Public Health Rep 111:146–151PubMedGoogle Scholar
  17. 17.
    Chevalley T, Herrmann F, Delmi M et al (2002) Evaluation of the age-adjusted incidence of hip fractures between urban and rural areas: the difference is not related to the prevalence of institutions for the elderly. Osteoporos Int 13:113–118PubMedCrossRefGoogle Scholar
  18. 18.
    Chevalley T, Guilley E, Herrmann F et al (2007) Incidence of hip fracture over a 10-year period (1991–2000): reversal of a secular trend. Bone 40:1284–1289PubMedCrossRefGoogle Scholar
  19. 19.
    Chapuy MC, Arlot ME, Duboeuf F et al (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327:1637–1642PubMedGoogle Scholar
  20. 20.
    Chevalley T, Rizzoli R, Nydegger V et al (1994) Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients. Osteoporos Int 4:245–252PubMedCrossRefGoogle Scholar
  21. 21.
    Feder G, Cryer C, Donovan S et al (2000) Guidelines for the prevention of falls in people over 65. The guidelines’ development group. BMJ 321:1007–1011PubMedCrossRefGoogle Scholar
  22. 22.
    Schaad M-A, Bonjour JP, Rizzoli R (2000) Evaluation of hormone replacement therapy use by the sales figures. Maturitas 34:185–191PubMedCrossRefGoogle Scholar
  23. 23.
    Schürch MA, Rizzoli R, Slosman D et al (1998) Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 128:801–809PubMedGoogle Scholar
  24. 24.
    Wysowski DK, Golden L, Burke L (1995) Use of menopausal estrogens and medroxyprogesterone in the United States, 1982–1992. Obstet Gynecol 85:6–10PubMedCrossRefGoogle Scholar
  25. 25.
    Wanner P, Sauvain-Dugerdil C, Guilley E et al (2005) Ages et générations: la vie après 50 ans en Suisse; analyse générale du recensement de la population 2000. OFS, NeuchâtelGoogle Scholar
  26. 26.
    Schürch MA, Rizzoli R, Mermillod B et al (1996) A prospective study on socioeconomic aspects of fracture of the proximal femur. J Bone Miner Res 11:1935–1942PubMedCrossRefGoogle Scholar
  27. 27.
    Lewinnek G, Kelsey J, White A et al (1980) The significance and a comparative analysis of the epidemiology of hip fractures. Clin Orthop Relat Res 152:35–43PubMedGoogle Scholar
  28. 28.
    Hagino H, Katagiri H, Okano T et al (2005) Increasing incidence of hip fracture in Tottori Prefecture, Japan: trend from 1986 to 2001. Osteoporos Int 16:1963–1968PubMedCrossRefGoogle Scholar
  29. 29.
    Iga T, Dohmae Y, Endo N et al (1999) Increase in the incidence of cervical and trochanteric fractures of the proximal femur in Niigata Prefecture, Japan. J Bone Miner Metab 17:224–231PubMedCrossRefGoogle Scholar
  30. 30.
    Kannus P, Niemi S, Parkkari J et al (1999) Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet 353:802–805PubMedCrossRefGoogle Scholar
  31. 31.
    Lönnroos E, Kautiainen H, Karppi P et al (2006) Increased incidence of hip fracture. A population based-study in Finland. Bone 39:623–627PubMedCrossRefGoogle Scholar
  32. 32.
    Avenell A, Gillespie WJ, Gillespie LD et al (2005) Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 20:CD000227Google Scholar
  33. 33.
    Lilliu H, Pamphile R, Chapuy MC et al (2003) Calcium-vitamin D3 supplementation is cost-effective in hip fractures prevention. Maturitas 44:299–305PubMedCrossRefGoogle Scholar
  34. 34.
    Kiel DP, Magaziner J, Zimmerman S et al (2007) Efficacy of a hip protector to prevent hip fracture in nursing home residents: the HIP PRO randomized controlled trial. JAMA 298:413–422PubMedCrossRefGoogle Scholar
  35. 35.
    Parker MJ, Gillespie WJ, Gillespie LD (2006) Effectiveness of hip protectors for preventing hip fractures in elderly people: systematic review. BMJ 332:571–574PubMedCrossRefGoogle Scholar
  36. 36.
    Hauselmann HJ, Rizzoli R (2003) A comprehensive review of treatments for postmenopausal osteoporosis. Osteoporos Int 14:2–12PubMedCrossRefGoogle Scholar
  37. 37.
    Black DM, Cummings SR, Karpf DB et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348:1535–1541PubMedCrossRefGoogle Scholar
  38. 38.
    McClung MR, Geusens P, Miller PD et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip intervention program study group. N Engl J Med 344:333–340PubMedCrossRefGoogle Scholar
  39. 39.
    Chevalley T, Hoffmeyer P, Bonjour JP et al (2002) An osteoporosis clinical pathway for the medical management of patients with low-trauma fracture. Osteoporos Int 13:450–455PubMedCrossRefGoogle Scholar
  40. 40.
    Feldstein A, Elmer PJ, Orwoll E et al (2003) Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation. Arch Intern Med 163:2165–2172PubMedCrossRefGoogle Scholar
  41. 41.
    Jachna CM, Shireman TI, Whittle J et al (2005) Differing patterns of antiresorptive pharmacotherapy in nursing facility residents and community dwellers. J Am Geriatr Soc 53:1275–1281PubMedCrossRefGoogle Scholar
  42. 42.
    Feldstein AC, Nichols G, Orwoll E et al (2005) The near absence of osteoporosis treatment in older men with fractures. Osteoporos Int 16:953–962PubMedCrossRefGoogle Scholar
  43. 43.
    Van Staa TP, Dennison EM, Leufkens HG et al (2001) Epidemiology of fractures in England and Wales. Bone 29:517–522PubMedCrossRefGoogle Scholar
  44. 44.
    Giversen IM (2007) Time trends of mortality after first hip fractures. Osteoporos Int 18:721–732PubMedCrossRefGoogle Scholar
  45. 45.
    Löfman O, Berglund K, Larsson L et al (2002) Changes in hip fracture epidemiology: redistribution between ages, genders and fracture types. Osteoporos Int 13:18–25PubMedCrossRefGoogle Scholar
  46. 46.
    Trombetti A, Herrmann F, Hoffmeyer P et al (2002) Survival and potential years of life lost after hip fracture in men and age-matched women. Osteoporos Int 13:731–737PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • E. Guilley
    • 1
  • T. Chevalley
    • 2
  • F. Herrmann
    • 2
  • D. Baccino
    • 1
  • P. Hoffmeyer
    • 3
  • C.-H. Rapin
    • 1
  • R. Rizzoli
    • 2
  1. 1.Centre for Interdisciplinary GerontologyUniversity of GenevaGenevaSwitzerland
  2. 2.Service of Bone Diseases, Department of Rehabilitation and GeriatricsUniversity Hospitals and Faculty of Medicine of GenevaGeneva 14Switzerland
  3. 3.Service of Orthopaedic Surgery, Department of SurgeryUniversity Hospitals and Faculty of Medicine of GenevaGenevaSwitzerland

Personalised recommendations